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I read with interest the study by Rawlings et al.,1 which showed an association between orthostatic hypotension (OH) and future risk of dementia. The article proposed a causative effect of OH, in addition to associated cardiovascular risk factors. The evidence presented, however, does not support this view. The strong association between OH and various cardiovascular risk factors—such as diabetes, smoking, hypertension, and antihypertensive drugs—is well-known. These increase risk of vascular dementia, and a majority of Alzheimer cases show increased cerebral vascular burden at autopsy.2 However, patients with OH without hypertension no longer showed significant association with cognitive decline.1 Presenting the raw data from the subgroup of patients without any cardiovascular risk factors would be helpful.
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- © 2019 American Academy of Neurology
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